Health Status and Health Care Utilization of Multiple Sclerosis in Canada

Abstract

Multiple sclerosis (MS) is a complex chronic neurological condition typically seen in young adults. Estimated prevalence rates of MS range from 55 to 240 per 100,000 in Canada, [1][2][3] making it one of the five most highly prevalent MS countries in the world (Northern US, Northern Europe, Australia, New Zealand). 4 The associated disability caused by this inflammatory autoimmune disorder of the central nervous system is substantial. Physical and psychosocial dimensions as well as overall quality of life are adversely affected by MS. 5,6 The array ABSTRACT: Background: Persons with multiple sclerosis (MS) represent a small segment of the population, but given the progression of the disease, they experience substantial physical, psychosocial and economic burdens. Objective: The primary aim was to compare demographic characteristics, health status, health behaviours, health care resource utilization and access to health care of the community dwelling populations with and without MS. Methods: Cross-sectional survey using data from the Canadian Community Health Survey (CCHS 1.1). Adjusted analyses were performed to assess differences between persons with MS and the general population, after controlling for age and sex. Normalized sampling weights and bootstrap variance estimates were used. Results: Respondents with MS were 7.6 times (95% CI: 5.4, 10.7) more likely to have health-related quality of life scores that reflected severe impairment than respondents without MS. Respondents with MS were 12.2 times (95% CI: 8.6, 17.2) to rate their health as 'poor' or 'fair' than the general population. Urinary incontinence and chronic fatigue syndrome were 18.7 times (95% CI: 12.5, 28.2) and 21.9 times (95% CI: 11.9, 40.3), more likely to be reported by respondents with MS than those without. Differences between the two populations also existed in terms of health care resource utilization and access and health behaviours. Conclusion: Large discrepancies in health status and health care utilization existed between persons with MS who reside in the community and the general population according to all indicators used. Health care needs of persons with MS were also not met. RÉSUMÉ: Sclérose en plaques, état de santé et utilisation des soins de santé au Canada.Contexte : Les individus atteints de sclérose en plaques (SEP) ne constituent qu'une petite partie de la population, mais ils portent un lourd fardeau physique, psychosocial et économique à cause de la progression de la maladie. Objectif : Le but premier de cette étude était de comparer les caractéristiques démographiques, l'état de santé, les comportements de santé, l'utilisation des ressources de soins de santé et l'accès aux soins de santé des individus vivant dans la collectivité, atteints ou non de la SEP. Méthodes : Il s'agit d'une étude transversale des données de l'Enquête sur la santé dans les collectivités canadiennes (ESCC 1.1). Nous avons analysé les données pour évaluer les différences entre les individus atteints de SEP et la population en général, après aju...

Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts

“…Other studies have also shown that the MS population has lower quality of life than the general population. 38 The HUI3 is strongly associated with physician-scored measures of disability, 39 which tend to worsen with older age, 40 consistent with our findings. Temporal trends in these associations have not been evaluated; thus, an assumption of stability in these trends across time was reasonable.…”

“…Although the rate of hospitalization has declined in the MS population over time, rates remain higher than in an age-and sex-matched population without MS. 42 Other health care services are also used more heavily by the MS population than the general population. 38 Prescription drug expenditures are particularly high, likely reflecting the very high costs of disease-modifying therapies for MS. 43 We observed that among those aged 20 to 34 years, the group most likely to be using disease-modifying therapies, prescription drug expenditures constituted 62.5% to 69% of total health care expenditures. In a survey of 1909 Americans with MS in 2006, disease-modifying therapies constituted the single biggest MSrelated cost, 44 and in a US-based study that used administrative data, pharmacy expenditures constituted 65% of total MS-related health care costs in 2004.…”

Comorbidity increases the risk of hospitalizations in multiple sclerosis

“…5 Health care utilization is high in the MS population, 6 with up to 25.8% of the MS population being hospitalized annually, 7 exceeding the rate of hospitalizations in the general population. 8 The mean number of physician visits per year is also higher in the MS population. 9 In other diseases, persons with multiple chronic health conditions have higher rates of health care utilization than persons with a single condition.…”

Sedentary Behavior and Blood Pressure in Patients with Multiple Sclerosis

“…1,2 Hypertension is one of the five leading causes of disability in the general population, 3 and hypertension is one comorbid condition that is prevalent and impactful among patients with MS. 4 Indeed, hypertension is the third most prevalent comorbidity in MS, 5 and, based on self-report, medical records, or formal evaluation, it affects 17.1% to 30.1% of patients with MS in North America. 4,[6][7][8] Patients with MS have an increased relative risk of cardiovascular disease, and this risk varies based on disease course. 9 Cardiovascular comorbidities, such as hypertension, are linked to more rapid progression of ambulatory disability and increased risk of cane use in patients with MS. 1,8 Pulse pressure (ie, the difference between systolic and diastolic pressures) also has been associated with ambulatory functioning in patients with MS. 10 Based on this literature, it is clear that hypertension and high blood pressure (BP) are prevalent and problematic conditions for patients with MS. Understanding factors such as lifestyle behaviors that may correlate with BP in patients with MS is important.…”